Infant Feeding

It’s a total myth that human breast milk is the same as formula milk. There are LOADS of health benefits for a baby who receives breastmilk and for a mother who breastfeeds.

Below is a chart detailing the key constituents of breast milk compared to artificial milk; adapted from UNICEF Baby Friendly Initiative Training.

The reason that the ‘bonus’ things in breastmilk cannot be added into formula is because they are live constituents and cannot be replicated in a lab.

For example- the immunoglobulins are how your body would identify any illnesses/ bacteria within your environment; your breastmilk would produce antibodies to these microbes and pass that to your baby. This also includes immunity to things you have had past contact with – such as COVID-19.

Health benefits for your baby if they receive breastmilk

• Sets up your baby’s microbiome for life. This means it can essentially turn on or turn off health receptors which may or may not predispose your child to that illness later in life
• Less likely to develop allergies, gastroenteritis, otitis media, urinary tract infections, obesity, diabetes, necrotising enterocolitis, childhood leukaemia, heart disease, dental caries
• Reduces the incidence of sudden infant death syndrome (SIDS)

Health benefits for you if you breastfeed

• Reduced chance of breast cancer, ovarian cancer and uterine cancer
• Reduced incidence of postnatal depression
• Able to lose excess weight quicker post baby

While you can see all the amazing health benefits for yourself and your baby if you choose to breastfeed, there are also some other amazing benefits including:

• It’s free to breastfeed your baby. It is estimated that formula milk alone will cost between £1000-£1500 in the first year of life. This is without including equipment such as bottles/ steriliser etc.
• Convenience – you do not need to prepare, sterilise, or have anything ‘in stock’ ready. You just need yourself and you are ready to go. Perfect for in the middle of the night when you have a hungry baby.
• Safety - we are extremely lucky in the UK to have access to clean drinking water, however there can be things that effect the safety of formula milk. For example; private water supplies/ travelling abroad with your baby/ formula being made up incorrectly/ not sterilising correctly etc. The factors can all pose significant risks to formula feeding. We also need to be aware that formula milk is a processed food, manufactured in a factory- therefore there can be risk of contamination at every production level.
• Environmental Impact - The formula industry causes a lot of issues within the environment- from the production in factories, packaging, distribution, use of fuel and waste products from the powder/ old bottles, and excesses of water needed to create the milk powder itself. There is also the increase energy usage from boiling kettles and sterilising equipment that you would not need with breastfeeding (this also affects your outgoings).
• NHS - as a result of the health benefits listed above, babies who are breastfed are 15% less likely to need a GP visit in the first 6 months of life and are 5 times less likely to be hospitalised with a gastro related illness in the first 6 months of life. There is also some research to suggest that if we could increase breastfeeding rates by even a very small percentage, we could save the NHS around £40 million a year from associated health benefits (UNICEF UK, 2012). We also have a very strong link between formula feeding and obesity- and at present obesity is one of the leading causes for other health issues developing and therefore an excessive cost to the NHS.

Our website has useful information to help support you with your feeding choices. It is important to discuss with your midwife throughout pregnancy, about the different choices on how to feed your baby and to seek any information/ support you need before your baby arrives.

In Powys we offer local antenatal classes hosted by the team of midwives who are caring for you. Our classes are based on the Solihull approach which covers how to respond to your baby’s needs and the options on how to feed your baby. This can be beneficial to yourself and your partner, to give you both information and practical skills before your baby arrives, and it is also a great way to meet other expectant mums and dads in the local area.

We have a Facebook page ‘Powys Natures Nourishment’, that has videos, links and support available.

You can also watch the videos below:

The Baby buddy app allows you to create your own digital buddy who can support you throughout your pregnancy and early parenthood up to 6 months.

Preparing for the birth

There are lots of ways you can start preparing yourself prior to birth about how you wish to feed your baby. Firstly, it is important to gather all the information (all available on this webpage and other suggested links), think about how you and your partner feel about feeding your baby and what support you have around you.

When your baby is first born, we call the first hour of their life – the golden hour. To midwives this is an extension of labour and is a short time of transition and familiarisation for you and your baby. Afterall, you have waited 9 months for this moment, and it is a special time we can protect.

The immediate hour following your baby being born has a massive effect on your baby’s microbiome (the goodness found in your baby’s gut). This will have a lifelong effect on your baby’s brain development and overall health and can also set off your mothering hormones. UNICEF and the NHS recommend babies have uninterrupted skin to skin following birth for at least 1 hour. This is so that they can adapt to extrauterine life- this means learn to breathe, change their respiratory and cardiac systems, and regulate their temperature. This special hour of life is best spent in the arms of the mother/ birthing person in skin to skin as this is known to reduce baby’s stress hormone levels, allowing them to transition more effectively.

We know that babies ideally need to feed in skin to skin within that first hour of life as it increases the chances of you successfully breastfeeding your baby. Within the breasts there are prolactin receptors which allow your breasts to produce milk; these receptors get switched into action when your baby feeds regularly, therefore to enable your breasts to produce enough milk for your baby you need to communicate between the breasts and your baby regularly, so that they can produce enough milk according to baby's needs.

The golden hour is the first gift you can give to your baby, and it is incredibly special for you too. All routine observations/ tests like weighing can be done once your baby has fed for the first time or should be done immediately post birth. Once babies are born, they must go through a 9-step cycle for them to be able to feed (see below). If your baby is interrupted at any stage before that first feed, the baby must restart the cycle and could therefore delay your baby feeding for the first time.

Stage 1 - Birth Cry - “Welcome to the world little one”- this is where baby inflates their lungs for the first time.

Stage 2 - Relaxation - “This is all a bit overwhelming; I am trying to transition into doing everything for myself- just give me a moment to take this all in” – this is where your baby looks completely relaxed and isn’t moving around much

Stage 3 - Awakening - “I can hear familiar things, this smells and sounds familiar to me”- This is where baby will start opening eyes and slow movements will start

Stage 4 - Activity - “This doesn’t feel scary, I can start exploring, I’m not in danger” This is where baby might start rooting by opening their mouth, or they may put their hands in their mouths. This is also when your baby is colonising their familiar bacteria from you and your partner

Stage 5 - Rest - “This is a bit tiring; I am just going to take a little rest. I have already learnt so much which I am processing so I can move onto the next stage soon” – This is where baby will appear to have a little rest, go quiet or stop wriggling around so much. The rest period can happen multiple times throughout the 9 stages.

Stage 6 – Crawling - “I can smell where I am going, and I want to help mum's uterus to contact” This is where baby will start crawling, moving their bodies towards the breast, rooting, drawing knees up to move.

Stage 7 - Familiarisation - “This is my mum, is not she amazing, I love her, I feel safe and secure. I am teaching myself how things should feel in my mouth, which will mean I will not need help later” This is one of the most important stages and should not be rushed. This usually takes about 20 minutes where baby will be rooting at the nipple, licking the nipple, grabbing at the breast, and latching on and off. This is how your baby teaches itself how to feed at the breast unaided.

Stage 8 – Suckling - “I did it all by myself and it tastes yummy” – This is where baby will be attached to the breast and feeding.

Stage 9 – Sleeping - “Life is so good”- this is where baby in content and feels safe. Likely to be asleep in skin to skin.

After the birth

The first few days of being a parent can be tricky as you and your baby are getting over the birth and getting to know one another. Most mothers who have breastfed will tell you that learning how to breastfeed can take a while, so give yourself time. Breastfeeding usually does not completely establish until around 6 weeks, but usually the first week is where any difficulties arise, while you are both starting to get to grips with everything.

Colostrum

Colostrum is the “liquid gold” that your breasts produce from around 16 weeks of pregnancy. It is the first milk a baby needs until around day 3 when the mature milk comes in. Colostrum is jam packed with amazing antibodies and calories to protect and nourish your baby. There are only small amounts of colostrum which is naturally the right amount for your new baby's tiny little tummy, and this will gradually increase with the days that pass.

Colostrum acts as a laxative to help your baby pass their first meconium stool (thick black tar substance), this reduces the risk of your baby developing jaundice and starts the digestive system working.

Also, remember that your baby has a brown fat store which means if your baby is a healthy, term baby, they also get energy stores from this over the first few days of life. 

Below is a visual guide, developed by Sharon Breward IFC at Betsi Cadwaladr health board, all about the wonderful power of colostrum

What is colostrum? (nhs.wales)

So how do I know my baby is hungry?

Your baby will show you feeding cues when they are hungry, the last sign of hunger is crying. If you wait for your baby to cry prior to feeding them, they might not latch as effectively, so getting to know your babies early and mid-cues are important.

Adapted from National Childbirth Trusts “1st 1000 days new parent support.”

Tips for calming the crying baby; cuddling, skin to skin, talking/singing, stroking.

Further information can be found on the following websites:

• Association of Breastfeeding Mothers web pages – support for common breastfeeding problems
• Baby Friendly Initiative - parents page – provides information on the Baby Friendly Initiative and the kind of breastfeeding support you can expect
• Best Beginnings web pages – video resources and step by step guides for how to ‘latch on’
• Breastfeeding Network web pages – information on common breastfeeding problems, such as sore nipples, blocked ducts, and mastitis
• Every Child Wales – useful tips to give your child a healthy and happy start to life. Public Health Wales have created 10 Steps to Healthy Weight to help families in Wales to bring up healthy and happy children
• Kelly Mom web pages – full of evidence based articles on feeding your baby
• La Leche League – a worldwide charitable organisation, founded to give information and encouragement to breastfeeding mothers
• National Childbirth Trust web pages – the UK’s largest charity for parents, supporting parents both before and after birth
• NHS Choices - Breastfeeding web pages – offers a range of pages on topics to promote health and wellbeing

If you are struggling to breastfeed your baby remember breastfeeding may be the natural way to feed a baby, but it is a skill that needs to be learnt by the both of you. Like most things you cannot expect to get it right straight away, and it is important to get loads of support. Remember; you would not just get in a car for the first time and be a perfect driver, it takes theory, practise, and support.

Get help: speak to other breastfeeding mums and Peer Supporters at the breastfeeding groups and through Facebook. Or contact your Midwife/Health Visitor for advice. Remember that there are several trained staff across Powys who will be able to support you if you chose to continue to breastfeed.

You can assess your own breastfeeding using this assessment tool below and if you tick NO to any of the columns then please contact your MW or HV so they can complete a full BF assessment with you and give you some support: UNICEF UK mothers breastfeeding checklist

If you are considering making the decision to give up breastfeeding, here are some useful things to think about:

• Have you been pressurised to give up? Is the information you have been given by friends, family or even health professional, correct?
• Have you experimented with your breastfeeding? Have you tried different positions or even expressing and feeding your baby from a cup/ spoon?
• Is mixed feeding an option? Although not ideal in the early days, mixed feeding may be an option later if you wish to return to work or if you are unable to make a full milk supply.
• You can take your time. You do not have to rush to give up breastfeeding, slowly weaning your baby is often best for both of you.
• It is okay to change your mind. If you give up breastfeeding but later decide to start breastfeeding again, it can be possible.
• Have I asked for support? Have I spoken to my Midwife, health visitor, nursery nurse, peer supporter, family, friends?

Finally, if you have had to stop breastfeeding remember any amount of breastfeeding is good for you and your baby.

Remember there are health benefits for you and your baby if you are only able or want to breastfeed for a few days.

If you are feeling low or upset, remember that good parenting is about more than how you choose to feed your baby. In addition, please talk to your Health Professional who will be able to support you.

Belinda Phipps of the National Childbirth Trust said: "Because the benefits start right from the first feed, any amount of breastfeeding is a reason to feel proud".

Information on common issues

• For more information around medications that you may be taking and the impact on breastfeeding, take a look at the drugs in breast milk fact sheet
• If you think your baby has a tongue tie, please speak to your Midwife or Health Visitor. You can also use the TABBY tool to assess the severity (if it scores less than 5, we can refer you to a specialist service). You can find information on tongue tie at this website
• If you are returning to work and require further information around breastfeeding and returning to work, please visit the Welsh Government website: Returning to work (Welsh government)

How you decide to feed your baby, is 100% your own personal choice. As a health board we will support, inform, and empower you to feed your baby in any way that you wish. If you decide that formula feeding is how you would like to feed your baby, please have a look through the information and links below to ensure you do it as safely as possible.

Formula milk is a manufactured milk that is designed for feeding babies under the age of 12 months of age. Formula milk is usually made from cow’s milk and can either be purchased as a ready-made liquid or a powder that you add water to. Formula will provide your baby with the nutrients your baby needs to grow and develop, however there are a lot of constituents that are found in breastmilk that cannot be replicated in formula milks, and that is why there are many more health benefits for your baby if they receive breast milk.

The Guide to Bottle Feeding leaflet (unicef.org.uk) has been developed by start for life, NHS, and UNICEF to compile all the information you need to know about formula milk and preparation/ sterilisation. Please click the link below to read more:

First Steps Nutrition and UNICEF, have a fantastic poster which goes through the principles of safe and responsive bottle feeding: Infant formula and responsive bottle feeding (unicef.org.uk)

Key points of the poster on responsive bottle feeding include:

1. Keeping baby close, promoting skin to skin opportunities with both mum and dad to aid bonding.
2. Feeding baby when they show early feeding cues.
3. Holding baby close in a semi-upright position, reassuring baby with eye contact.
4. Gently invite baby to open their mouth by brushing the teat against their top lip. Keeping the bottle horizontal to pace the milk flow.
5. Watch baby for cues that they may need a break, or to end the feed; milk dribbling from mouth, turning head away, splaying fingers/toes.
6. Do not try to force a baby to finish the feed, a well-baby knows how much milk they require.

First Steps Nutrition also shares information on what infant formula to choose. It promotes that first milk is suitable for the first year and there is no need for additional/follow on formulas: Infant milks for parents & carers — First Steps Nutrition Trust

Combination Feeding

It is important to remember that you do not just have to pick one method of feeding your baby – combination feeding or giving expressed breastmilk has many health benefits for both you and your baby. Therefore, if you are wanting to formula feed for much of your early parenting journey, there are ways you can incorporate breastmilk alongside. Some things you may wish to consider are:

• Antenatal expressing of colostrum- this is the milk that will be in your breasts from around 16 weeks' gestation. You can start to harvest/ express this from 37 weeks' gestation and store it in a sterile container in your freezer. This would mean that your baby could have colostrum for their first few feeds (recommended by UNICEF/ WHO (World Health Organisation)).
• Offer the baby to have some breastfeeds in the first few days of life and see how you feel, while possibly having bottles of formula also. (NB: this could negatively affect breastmilk supply), however if it is the difference between your baby having some or no breastmilk- then this is a fantastic option for giving your baby and yourself some of those amazing health benefits in the first few days of life- which last a lifetime.
• Babies do not just have to feed directly from the breast. There are electric, manual and suction breast pumps which can help you express your breastmilk to give to your baby.

If you wish to find out more about other options, please contact your midwife or health visitor.

Powys Midwifery Service- 01874 622443- Midwives are on call 24/7 (until baby is 28 days old or you're discharged from midwifery care) for any infant feeding queries and support.

Powys Health Visiting –  Your health visitor will provide you with local contact details following your first visit. Please speak to your community midwife if you have not heard from your health visitor before being discharged from midwifery care.

Here are some useful contacts:

Ystradgynlais 01639 846485

Brecon 01874 622186

Llandrindod Wells 01597 828746

Knighton 01547 521226

Machynlleth 01654 705236

Llanidloes 01686 414232

Newtown 01686 617480

Welshpool 01938 555137

Llanfyllin 01938 558972

Powys Natures Nourishment is our health board approved Facebook page where you can access information through different medias online, including links to reputable sites and information you might find useful throughout your infant feeding journey. This service also offers an instant messaging advice service with our infant feeding coordinator for any generic infant feeding issues.

National Breastfeeding Helpline- 0300 100 0212 Peer Supporter available 9:30- 21:30, and now offering nighttime support under a pilot scheme from 21.30-09.30

Association of Breastfeeding Mothers – 0300 330 5453

The ABM is a breastfeeding charity dedicated to supporting breastfeeding mums and families.

La Leche League- 0345 120 2918

La Leche League provide mother-to-mother, parent-to-parent breastfeeding support across Great Britain and the Isle of Man.

National Childbirth Trust (NCT)- 0300 330 0700

The NCT helpline provides practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers.

The Breastfeeding Network support line - 0300 100 0212

The Breastfeeding Network provides a 24/7, volunteer run, telephone breastfeeding support service.

Support is also available in Welsh and Polish via the National Breastfeeding Helpline (9:30am – 9:30pm) – call 0300 100 0212 and press 1 for Welsh and 2 for Polish. To access the service in Bengali and Sylheti- 0300 456 2421

Support is invaluable throughout your breastfeeding journey. Whether you just want to connect with other parents or need to seek practical or emotional peer support, there are groups across Powys to support you.

We aim to try and keep this list up to date, however, please check on each group’s social media pages for any updates to date, time or venue.

The groups available in Powys are:

North Powys

Machynlleth at Vane Tempest Room, Y Plas on Friday mornings (bi-weekly) 10.30 - 12.00. Contact via Facebook.

Llanidloes at The Marquee at the Crown and Anchor on Thursday mornings 09.30-12.30. Contact via Facebook.

Welshpool at Costa in Welshpool. Friday mornings 10.15 - 11.30. Contact via Facebook.

Newtown at The Portacabin at Newtown Intergrated Family Centre on Wednesday afternoons 13.15-14.15. Contact via Facebook

South Powys

Ystradgynlais – offering 1 to 1 support online. Contact via La Leche League of Swansea Valley | Facebook.

Brecon at The Muse, Glamorgan St on Thursday mornings 10-12. Contact via Brecon BIBS | Facebook

Llandrindod Wells at Ysgol Trefonnen's Multi-Purpose Room 10am-12 Thursdays (term-time). Contact via  Facebook.

Knighton & Presteigne – offering 1 to 1 support online. Contact Knighton and Presteigne Breastfeeding Group | Facebook.

Please ask your midwife or health visitor for further information about other local breastfeeding groups. 

Interested in becoming a Peer Supporter in Powys?

Please contact your local BIBS group or email laura.c.bache@wales.nhs.uk for further information.

If you would like to share your story, you can contact us via email:  PTHBInfantFeeding@wales.nhs.uk